1 Social Determinants of Health
Explore how social, economic, and environmental conditions shape health, how their effects can accumulate across life, and why improving health requires attention beyond medical care.
What shapes health
are the nonmedical conditions in which people are born, grow, learn, live, work, play, and age, as well as the wider systems and forces shaping those conditions. They influence exposure to health risks, access to resources, and the ability to maintain health and recover from illness. Health care matters, but it is only one part of this broader picture.
The are connected rather than isolated. For example, low income can limit housing choices, while housing location can affect exposure to pollution, access to healthy food, and travel time to health services.
Five connected domains
The framework groups social determinants into five domains:
: income, employment, food security, and housing stability.
Education access and quality: early learning, educational opportunity, literacy, and language access.
: the availability, affordability, accessibility, and quality of health services.
Neighborhood and built environment: housing conditions, transportation, safety, food options, and exposure to pollution or other hazards.
Social and community context: relationships, social support, discrimination, community safety, and civic inclusion.
These domains overlap. For instance, education can support health literacy and expand employment opportunities, while income can make it easier to afford nutritious food, safe housing, transportation, and health care.
How conditions influence health
Social and economic resources affect both exposure to health risks and access to ways of preventing or addressing them. Insecure work may involve low pay, unpredictable hours, or hazardous conditions, making it harder to attend appointments or avoid injury.
Physical environments also shape health. Clean air and water, safe housing, accessible parks, and reliable transportation can support health. Pollution, extreme temperatures, unsafe streets, and poor housing conditions can increase illness or injury and constrain daily choices. Supportive relationships can provide practical and emotional help, while discrimination, violence, or isolation can create stress and restrict access to opportunities.
These influences interact. A person’s health is not determined by one factor alone, and the same condition may affect people differently depending on their resources, health, and circumstances. Wider systems—including policies, economic arrangements, and social norms—help distribute resources and risks across communities. On average, people with fewer social and economic resources face greater health risks and barriers, a pattern called the .
Health across the
Social determinants can affect health at every stage of life. Conditions during pregnancy and early childhood can influence development. The quality of schools, family resources, and neighborhood safety can shape children’s physical and emotional well-being.
In adolescence and adulthood, education, employment, income, social relationships, and working conditions can affect immediate health and later opportunities. In older age, income, housing accessibility, social connection, transportation, and access to appropriate care can influence independence, well-being, and the ability to manage illness.
Effects may accumulate over time. Repeated exposure to unsafe housing or chronic financial stress can contribute to health problems. Early advantages or disadvantages may also affect later access to education, employment, income, and care. These patterns are not inevitable: supportive relationships, improved living conditions, effective services, and changes in policy or community resources can reduce risks and improve health at different ages.
Care access and unequal outcomes
Access to health care is itself a social determinant, but it depends on more than whether a clinic exists. Affordability, insurance, transportation, time away from work, language access, disability accommodations, and the quality and acceptability of care can all affect whether people receive appropriate services. Social and economic conditions can shape when people seek care, whether they can continue treatment, and how well they recover.
When resources and risks are distributed unequally, groups may experience avoidable differences in illness, disability, and life expectancy. These are not simply the result of individual choices: choices are made within the opportunities and constraints of people’s environments.
Improving health therefore often requires action beyond medical care. Relevant areas include housing, education, working conditions, transportation, environmental safety, and access to quality services. Attention to both people’s living circumstances and the care they receive can address factors that shape health throughout life.